BILATERAL MOVEMENT-BASED COMPUTER GAMES IMPROVE SENSORIMOTOR FUNCTIONS IN SUBACUTE STROKE SURVIVORS: A RANDOMIZED CONTROLLED TRIAL

Background: Stroke is a leading cause of disability worldwide, often resulting in upper limb motor impairment and reduced grip strength. Effective rehabilitation strategies are essential to restore functional independence in stroke survivors. Brunnstrom Movement Therapy (BMT) and Mirror Therapy (MT) are widely used neurorehabilitation techniques, each leveraging distinct mechanisms to enhance motor recovery. However, the comparative efficacy of these interventions in improving upper limb function and grip strength remains an area of investigation. Objective: To compare the effects of Brunnstrom Movement Therapy and Mirror Therapy on upper limb function and grip strength in stroke survivors. Methods: This experimental study included 32 stroke survivors, equally divided into two groups: the BMT group (n=16) and the MT group (n=16). Participants aged 40–65 years with ischemic or hemorrhagic stroke and upper limb motor impairment (Brunnstrom stages 2–5) were recruited. Both groups underwent 45-minute therapy sessions, five times per week, for six weeks. Upper limb function was assessed using the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), while grip strength was measured using a handheld dynamometer. Within-group and between-group analyses were conducted using SPSS version 22, with statistical significance set at p < 0.05. Results: Both therapies significantly improved upper limb function and grip strength (p < 0.001). The BMT group exhibited a greater improvement in FMA-UE scores (45.8 ± 4.9 vs. 42.3 ± 5.0, p = 0.04) and grip strength (24.6 ± 3.5 kg vs. 22.1 ± 3.3 kg, p = 0.03) compared to the MT group. The percentage increase in FMA-UE was 29.01% for BMT and 17.50% for MT, while grip strength improved by 33.70% in the BMT group and 18.18% in the MT group. Conclusion: Both interventions contributed to upper limb motor recovery, but Brunnstrom Movement Therapy demonstrated superior effectiveness in improving motor function and grip strength. These findings suggest that task-specific training may yield better functional outcomes in stroke rehabilitation.

Effects of Repetitive Facilitative Exercise on Spasticity in the Upper Paretic Limb After Subacute Stroke

IntroductionActivation of the unaffected hemisphere contributes to motor function recovery post stroke in patients with severe upper limb motor paralysis. Transcranial direct current stimulation (tDCS) has been used in stroke rehabilitation to increase the excitability of motor-related areas. tDCS has been reported to improve upper limb motor function; nonetheless, its effects on corticospinal tract excitability and muscle activity patterns during upper limb exercise remain unclear. Additionally, it is unclear whether simultaneously applied bihemispheric tDCS is more effective than anodal tDCS, which stimulates only one hemisphere. This study examined the effects of bihemispheric tDCS training on corticospinal tract excitability and muscle activity patterns during upper limb movements in a patient with subacute stroke.MethodsIn this single-case retrospective study, the Fugl–Meyer Assessment, Box and Block Test, electromyography, and intermuscular coherence measurement were performed. Intermuscular coherence was calculated at 15–30 Hz, which reflects corticospinal tract excitability.ResultsThe results indicated that bihemispheric tDCS improved the Fugl–Meyer Assessment, Box and Block Test, co-contraction, and intermuscular coherence results, as compared with anodal tDCS. Discussion: These results reveal that upper limb training with bihemispheric tDCS improves corticospinal tract excitability and muscle activity patterns in patients with subacute stroke.

Background: The Nintendo Switch® (NS) is the ninth video game console developed by Nintendo®. Joy-Cons® are the primary game controllers for the NS® video game console, and they have an infrared motion camera sensor that allows capturing the patient’s hands without the need to place sensors or devices on the body. The primary aim of the present study was to evaluate the effects of the NS®, combined with a conventional intervention, for improving upper limb (UL) grip muscle strength, coordination, speed of movements, fine and gross dexterity, functionality, quality of life, and executive function in multiple sclerosis (MS) patients. Furthermore, we sought to assess satisfaction and compliance levels. Methods: A single-blinded, randomized clinical trial was conducted. The sample was randomized into two groups: an experimental group who received treatment based on Dr Kawashima’s Brain Training® for the NS® (20 min) plus conventional rehabilitation (40 min), and a control group who received the same conventional rehabilitation (60 min) for the ULs. Both groups received two 60 min sessions per week over an eight-week period. Grip strength, the Box and Blocks Test (BBT), the Nine Hole Peg Test (NHPT), the QuickDASH, the Multiple Sclerosis Impact Scale (MSIS-29), the Trail Making Test (TMT), and the Stroop Color and Word Test (SCWT) were used pre- and post-treatment. Side effects and attendance rates were also recorded. Results: Intragroup analysis showed significant improvements for the experimental group in the post-treatment assessments for grip strength in the more affected side (p = 0.033), the BBT for the more (p = 0.030) and the less affected side (p = 0.022), the TMT (A section) (p = 0.012), and the QuickDASH (p = 0.017). No differences were observed for the control group in intragroup analysis, but they were observed in the NHPT for the more affected side (p = 0.012). The intergroup analysis did not show differences between both groups. Conclusions: Our results show that an eight-week experimental protocol, after using Dr Kawashima’s Brain Training® and the right-side Joy-Con controller for the NS®, combined with a conventional intervention, showed improvements in grip strength, coordination, fine and gross motor function, executive functions, and upper limb functionality in the experimental group. However, no differences were observed when both groups were compared in the intergroup analysis. The addition of Brain Training® for the NS® for the upper limb rehabilitation did not show side effects and was rated with a high satisfaction and excellent compliance in people with MS. Trial registration: This randomized controlled trial has been registered at ClinicalTrials Identifier: NCT04171908, November 2019.

Abstract: Introduction. In stroke survivors, the incidence of upper limb motor disability remains high, many of them having persistent neurological deficits that restrict activities and limit social participation. Although in many cases it is not possible to fully return to pre-stroke functional status, to treat the stroke survivors sustained and complex rehabilitation is essential. The study aim was to analyse the impact of neuromuscular rehabilitation based on mirror therapy in addition to a conventional upper limb rehabilitation program on upper limb functions and motor skills in patients with chronic stroke at a comprehensive physical rehabilitation Center. Methods: this observational study was conducted on a group of 30 post-stroke patients who met the inclusion criteria and signed informed consent, between February and May 2025, in the city of Craiova, at the Day Center for Adults with Disabilities. Participants were allocated into 2 groups, group A-MT and group B-CT according to the therapy they received. Both groups participated in a stroke rehabilitation program and group A was given mirror therapy in addition. The rehabilitation program was performed 3 days per week for 12 weeks. The motor functioning of the upper limb and functional independence were assessed before the intervention (T0), 3 months after starting the rehabilitation program T1, between the two groups and within groups, and at the 3 months follow-up, T2. Results: an improvement in all parameters evaluated was observed in both groups, but the postintervention scores were significantly higher in the mirror therapy group. We found significant differences between the mirror therapy group A and rehabilitation group B when compared UL abilities at the end of 12 weeks therapy: A 40.1 ± 6.26, B 36.1 ± 6.34, p=0.046. Conclusions: Mirror treatment used in addition to conventional stroke rehabilitation therapy seems to be an effective method to increase functional and motor skills of the upper extremity in elderly patients' post-stroke compared to conventional therapy. Keywords: stroke; rehabilitation; mirror therapy; spastic upper limb

Both HIV infection and alcoholism can impair motor abilities involving manual dexterity and postural stability. Given the high prevalence of HIV and alcoholism comorbidity, we examined whether each disease selectively disrupts different components of upper and lower limb motor control and whether these impairments are compounded by disease comorbidity. Simple and complex upper (speed and finger dexterity) and lower (static posture) limb functions were tested in 31 men with HIV infection, 27 with alcoholism, 43 comorbid for HIV infection and alcoholism, and 22 normal healthy controls to assess whether comorbid patients would demonstrate greater motor impairment relative to those with a single diagnosis. Individuals with HIV infection and those with alcoholism had impaired upper and lower limb motor function. Disease comorbidity compounded deficits in speeded finger movement. Neither Beck Depression Inventory scores, self-reported peripheral neuropathy, nor HIV medication accounted for group differences. Lower limb motor composite scores with eyes open were correlated with upper limb motor scores in the alcoholism group. Overall, the observed impairment patterns indicate the presence of upper and lower limb motor impairment in both HIV infection and alcoholism and the relevance of alcoholism in exacerbating impairment in speeded fine finger movement, when it occurs in HIV infection.

BackgroundStroke is one of the most common cerebral vascular diseases, usually affecting people aged 60 years and older. It leads to a variety of disabilities requiring motor and cognitive rehabilitation. Poststroke rehabilitation is critical for recovery, particularly for upper limb impairments, which affect approximately 80% of stroke survivors. Conventional rehabilitation often faces barriers such as cost, accessibility, and patient adherence. In contrast, eHealth technologies offer a promising alternative by providing accessible, cost-effective, and engaging rehabilitation solutions.ObjectiveWhile numerous systematic reviews have explored various aspects of technology-based rehabilitation for poststroke upper limb recovery, there is a notable lack of comprehensive synthesis of these findings. This gap presents challenges, primarily due to the focus on specific technologies, which complicates understanding the overall effectiveness of these interventions. Consequently, clinicians and researchers may find it difficult to assess the field holistically, potentially hindering informed decision-making in clinical practice. This review synthesizes evidence from systematic reviews evaluating the effectiveness of eHealth technology–based interventions for upper limb recovery in poststroke individuals. Two main questions are examined: (1) Are eHealth technology–based therapies more or equally effective than conventional therapies for stroke rehabilitation? (2) What are the main clinical considerations for low-cost eHealth technology–based rehabilitation?MethodsComprehensive literature searches were conducted in PubMed, Web of Science, Scopus, Embase, and Google Scholar using predefined inclusion criteria based on the Population, Intervention, Comparison, Outcome, and Study Design (PICOS) framework. Systematic reviews published in English without date restrictions were included. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flowchart guided study selection. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR 2) criteria.ResultsA total of 1792 records were screened, resulting in 7 systematic reviews published between 2019 and 2023 being included. These reviews encompassed 95 studies involving 2995 participants with a mean age of 58.8 years across acute, subacute, and chronic stroke phases. Interventions included telerehabilitation, mobile health (mHealth) apps, augmented reality (AR), virtual reality (VR), wearable devices, and exergames. While AR and VR demonstrated potential benefits when combined with conventional therapies (eg, AR showing significant improvements in upper limb function with a standardized mean difference 0.657; P<.001), evidence for stand-alone effectiveness remained inconclusive due to heterogeneity in study designs, intervention protocols, and outcome measures. Most reviews were rated as critically low quality due to methodological limitations.ConclusionseHealth technologies hold promise for enhancing upper limb rehabilitation post stroke by addressing barriers such as cost and accessibility while providing engaging interventions. However, the field remains fragmented with insufficient evidence to establish clear efficacy. Future research should focus on standardizing protocols, optimizing neurorehabilitation principles such as dosage and task specificity, and improving methodological rigor to evaluate these interventions’ long-term impact better.

Balance dysfunction is common after stroke, yet subacute patients often are often unable to perform traditional Baduanjin exercises due to severe motor impairments. The objective of this study was to determine whether a modified Baduanjin program, adapted to sitting and standing positions, could improve balance function in subacute stroke survivors beyond conventional rehabilitation. Fifty-four subacute stroke patients were randomly assigned to receive either conventional rehabilitation plus modified Baduanjin (40 min daily, n = 27) or conventional rehabilitation alone (80 min daily, n = 27), five days per week for six weeks. The primary outcome was performance on the Berg Balance Scale (BBS); secondary outcomes included lower extremity motor function (FMA-LE), functional independence (MBI), and dynamic balance during walking assessed by 3D motion analysis. Patients in the modified Baduanjin group demonstrated significantly greater improvements in balance (BBS: between-group difference 6.1 points, 95% CI: 2.5–9.7, p = 0.001), lower extremity motor function (FMA-LE: 2.3 points, p = 0.019), and functional independence (MBI: 8.4 points, p < 0.001) compared to controls. Dynamic balance during walking, as measured by mediolateral sway amplitude, also showed greater improvement in the intervention group (p = 0.015). The intervention was associated with high adherence (94%) and was well tolerated, with no serious adverse events reported. Modified Baduanjin is expected to become a safe and viable adjunctive intervention that could help patients with subacute stroke improve their balance in addition to conventional rehabilitation. These preliminary findings warrant confirmation by multicenter trials on a larger scale.

Background:Upper limb motor impairment is a common complication following stroke. Although few treatments are used to enhance motor function, still approximately 60% of survivors are left with upper limb motor impairment. Several studies have investigated vagus nerve stimulation (VNS) as a potential technique for upper limb function. However, the efficacy and safety of VNS on upper limb motor function after ischemic stroke have not been systematically evaluated. Therefore, a meta-analysis based on randomized controlled trial will be conducted to determine the efficacy and safety of VNS on upper limb motor function after ischemic stroke.Method:We searched PUBMED, MEDLINE, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure Library (CNKI), and Wan Fang Database until April 1, 2021.Results:Six studies consisting of 234 patients were included in the analysis. Compared with control group, VNS improved upper limb function via Fugl-Meyer Assessment-Upper Extremity (mean difference = 3.26, 95% confidence interval [CI] [2.79, 3.74], P < .00001) and Functional Independence Measurement (mean difference = 6.59, 95%CI [5.77, 7.41], P < .00001), but showed no significant change on Wolf motor function test (standardized mean difference = 0.31, 95%CI [–0.15, 0.77], P = .19). The number of adverse events were not significantly different between the studied groups (risk ratio = 1.05, 95%CI [0.85, 1.31], P = .64).Conclusion:VNS resulted in improvement of motor function in patients after ischemic stroke, especially in the sub-chronic stage. Moreover, compared with implanted VNS, transcutaneous VNS exhibited greater efficacy in poststroke patients. Based on this meta-analysis, VNS could be a feasible and safe therapy for upper limb motor impairment.

Rehabilitation of the upper arm early after stroke: Video games versus conventional rehabilitation. A randomized controlled trial.

To characterize individuals with stroke who responded or did not respond to upper limb motor treatment by analyzing muscle synergy patterns (similarity, merging, and fractionation). This study is a secondary analysis of a multicenter randomized controlled trial. Inpatients of 2 specialized neurorehabilitation hospitals. We enrolled individuals (N=62) with a unilateral first-event ischemic or hemorrhagic stroke and severe-to-mild upper limb motor impairment (Fugl-Meyer Assessment-Upper Extremity score of 5-61, of 66). We excluded people with untreated seizure, severe cognitive, or verbal comprehension impairment. After randomization, individuals were allocated to conventional, virtual reality, or robot-assisted treatment groups (20 sessions, 1 h/d, 5 d/wk, 4wk). A blinded assessor performed assessments both before and after the intervention. Surface electromyography recordings from 16 muscles during reaching tasks were collected pre- and post-treatment. We extracted muscle synergy patterns (similarity, merging, and fractionation) of the stroke-affected and unaffected upper limb of each subject. Overall, individuals improved upper limb motor function (Fugl-Meyer Assessment-Upper Extremity change score=7.14±7.46; P<.001). We identified 34 responders to treatment showing clinically significant improvement (over the Minimal Clinically Important Difference of 5 points on the Fugl-Meyer Assessment-Upper Extremity). The responders showed decreased merging of synergies (P=.016) as compared with the non-responders (P=.025), who conversely showed improved similarity of synergies (P=.006). In individuals with stroke undergoing upper limb motor rehabilitation, changes in the synergy merging pattern may serve as a potential marker to distinguish responders from non-responders.

Cortical excitability of motor anticipatory in subacute stroke patients after virtual reality training: A preliminary movement-related potential study

This study aimed to explore correlations between spasticity and motor impairments in the upper and lower limbs in ambulatory chronic stroke survivors. We performed clinical assessments in 28 ambulatory chronic stroke survivors with spastic hemiplegia (female: 12; male: 16; mean ages = 57.8 ± 11.8 yrs; 76 ± 45 mos after stroke). In the upper limb, spasticity index and Fugl-Meyer Motor Assessment showed a significant correlation. Spasticity index for the upper limb showed a significant negative correlation with handgrip strength of the affected side ( r = -0.4, P = 0.035) while Fugl-Meyer Motor Assessment for the upper limb had a significant positive correlation ( r = 0.77, P < 0.001). In the LL, no correlation was found between SI_LL and FMA_LL. There was a significant and high correlation between timed up and go test and gait speed ( r = 0.93, P < 0.001). Gait speed was positively correlated with Spasticity index for the lower limb ( r = 0.48, P = 0.01), and negatively correlated with Fugl-Meyer Motor Assessment for the lower limb ( r = -0.57, P = 0.002). Age and time since stroke showed no association in analyses for both upper limb and lower limb. Spasticity has a negative correlation on motor impairment in the upper limb but not in the lower limb. Motor impairment was significantly correlated with grip strength in the upper limb and gait performance in the lower limb of ambulatory stroke survivors.

Brain lesion characteristics (timing, location, and extent) and the type of corticospinal tract (CST) wiring have been proposed as determinants of upper limb (UL) motor function in unilateral cerebral palsy (uCP), yet an investigation of the relative combined impact of these factors on both motor and sensory functions is still lacking. Here, we first investigated whether structural brain lesion characteristics could predict the underlying CST wiring and we explored the role of CST wiring and brain lesion characteristics to predict UL motor and sensory functions in uCP. Fifty-two participants with uCP (mean age (SD): 11 y and 3 m (3 y and 10 m)) underwent a single-pulse Transcranial Magnetic Stimulation session to determine CST wiring between the motor cortex and the more affected hand (n = 17 contralateral, n = 19 ipsilateral, and n = 16 bilateral) and an MRI to determine lesion timing (n = 34 periventricular (PV) lesion, n = 18 corticosubcortical (CSC) lesion), location, and extent. Lesion location and extent were evaluated with a semiquantitative scale. A standardized protocol included UL motor (grip strength, unimanual capacity, and bimanual performance) and sensory measures. A combination of lesion locations (damage to the PLIC and frontal lobe) significantly contributed to differentiate between the CST wiring groups, reclassifying the participants in their original group with 57% of accuracy. Motor and sensory functions were influenced by each of the investigated neurological factors. However, multiple regression analyses showed that motor function was predicted by the CST wiring (more preserved in individuals with contralateral CST (p < 0.01)), lesion extent, and damage to the basal ganglia and thalamus. Sensory function was predicted by the combination of a large and later lesion and an ipsilateral or bilateral CST wiring, which led to increased sensory deficits (p < 0.05). These novel insights contribute to a better understanding of the underlying pathophysiology of UL function and may be useful to delineate individualized treatment strategies.

BackgroundPost-stroke aphasia concurrent with upper limb (UL) motor dysfunction is very common and difficult to rehabilitate. Although mirror therapy (MT) has demonstrated efficacy in treating aphasia and UL motor dysfunction separately, it has not been utilized to address both conditions simultaneously. Our study introduces a novel Synchronous Mirror Therapy (SMT) system that integrates speech-language therapy with UL motor training to evaluate its clinical feasibility, preliminary efficacy, and potential cortical mechanisms.MethodFifteen patients and five therapists participated in this study. The patients had aphasia and UL motor dysfunction and underwent the SMT intervention ten times. They were evaluated through functional assessment scales (Aphasia Quotient of Western Aphasia Battery (WAB-AQ); Assessment of Fugl-Meyer Upper Limb scale (FMA-UL); Action Research Arm Test (ARAT)) and three questionnaires, and functional near-infrared (fNIRS) test. We analyzed the questionnaire results, functional changes before and after SMT, and differences between the SMT intervention and rest periods.ResultsNine patients underwent all SMT treatment sessions. Patients and therapists gave high ratings for SMT. Compared with before SMT interventions, significant improvements were observed in language function (WAB-AQ: p = 0.008) and UL motor function (FMA-UL: p = 0.007; ARAT: p = 0.016) after all SMT interventions, along with significant changes in three fNIRS channels (channel 9, p < 0.001; channel 20, p = 0.005; channel 30, p = 0.046) during the SMT intervention.ConclusionThe SMT intervention demonstrated feasibility and received positive feedback from both patients and therapists. The results indicate potential benefits of SMT in improving language and UL motor function for post-stroke patients. fNIRS findings suggest possible enhanced cortical activation during SMT, which may be associated with neural recovery processes. While encouraging, this still necessitates validation through larger sample sizes and rigorous randomized controlled designs.